Republic of Fiji Islands International Antibiotic Awareness Week November 16-22 2015 Jeremaia Mataika and Nargina Macalinao, Essential Medicines Authority, Fiji Pharmaceutical and Biomedical Services The World Antibiotic Awareness Week was held in Fiji from the 16 th to the 22 nd November 2015. This was the first year that a World Antibiotic Awareness Week has been held to help raise the awareness of antibiotic resistance and promote the responsible use of antibiotics. The threat of antibiotics losing their effectiveness has become so serious that the World Health Organisation has seen the need for a global campaign to use antibiotics wisely. When they are used unwisely, for example if instructions are not followed by the patient, they can lose their power to treat infections. The threat is as serious in Fiji as anywhere else. Antimicrobial use in Fiji Government health facilities In Fiji we are aware that the inappropriate use of antimicrobials contributes to the emergence of resistance to antimicrobials. We are also aware that the use of certain antimicrobials in animals is also associated with resistance to these antimicrobials. In Fiji s Government health facilities, antimicrobial use is guided by the Antibiotic Standard Treatment Guidelines (STGs) which were developed and approved for use in Fiji by the National Medicines and Therapeutic Guidelines committee. The third edition of the Antibiotic Guidelines was published in 2011. 1 These guidelines provide recommendations for use of antibiotics in all levels of the health services that are appropriate for the conditions commonly seen in Fiji. Nevertheless, there has been considerable anecdotal information that indicates some confusion and misinformation about antibiotics and their use within the Fijian community. Surveys: To get a better understanding of knowledge about antibiotics in Fiji, three major surveys were carried out under the leadership of the FPBSC Essential Medicines Authority (EMA). The findings helped identify targets to address during the planned Antibiotic Awareness Week. (i) Use of meropenem a restricted antibiotic in the Colonial War Memorial Hospital (CWM). There was evidence that this restricted antibiotic was being used excessively in hospitals and here was fear of developing resistance so a study of its use was undertaken under the supervision of the EMA in the CWM Hospital. The meropenem study can be accessed on the FPBS website. http://www.health.gov.fj/wp- content/uploads/2015/04/drug- Use- Evaluation- Report- Meropenem- CWMH- 2015.pdf Implementation of the recommendations resulting from the study findings will improve the use of meropenem in Fiji hospitals and will result in considerable cost savings. The recommendations must be implemented. 1 Antibiotic Guidelines, 3 rd Edition 2011, available from http://www.health.gov.fj/?page_id=198 1
(ii) Survey of community knowledge about antibiotics: Because there has been considerable anecdotal information indicating some confusion and misinformation about antibiotics and their use within the Fijian community, a community- wide survey was planned: To gain understanding of Fijian people s perception about antibiotics and their role and to provide the World Health Organization and the MoHMS with baseline data for the development and dissemination of Fiji Antibiotic Awareness Week materials (November 16-22), which would be appropriate for the Fijian population. To provide baseline data for targeted interventions regarding antimicrobial and general medicine use for the Fijian population. To gather information that would assist the development of Antimicrobial Stewardship in Fiji. Because a survey that involved visits to every section of the country was logistically and financially impossible the survey was conducted at the Hibiscus Festival in Suva in August to provide access to people from the entire country who gathered for the festival. The study sample size of 5000 participants was sufficiently representative of the 2007 Fiji Census population data. That study was supplemented by focus group discussions with 5 different groups of community people: GPS, retail pharmacists, over 55s, mothers with small children, young people age 18-25. An enormous amount of useful information about community knowledge was gathered. Targets for more community education were identified. The report will be available on the MoHMS website, together with the report of the Focus Group Discussions. Funding for these surveys and for coordination by Crystal Yim, provided by WHO Suva office, is gratefully acknowledged. Some Survey Findings 5000 participants from all areas of Fiji were interviewed at the Hibiscus Festival by a MoHMS team to get information about Fijians understanding about antibiotics and antibiotic resistance. The survey found that: 45.1% of the participants who had completed primary school only, did not know what antibiotics were; 25.9% completing some high school and 22.5% (less than one quarter) completing technical did not know what antibiotics were. Antibiotics were used to treat headache, dengue, asthmas, pregnancy and pain. 34.1% (about one third) of the participants who stated they knew what antibiotics were, used the medicine for a cold, 25% of those used them for flu and 5.3% of them used antibiotics for a virus. (iii) Survey of antibiotic prescribing and community knowledge in Out Patient Departments (OPDs) of Divisional Health Facilities: During Antibiotic Awareness Week, under the supervision of the EMA, a study of was begun of prescribing and community knowledge in the Divisional Health Centre OPDs as well as a study of the use of collistin a restricted antibiotic in the major hospitals. The need for both these studies had been recognised by the Chief Pharmacist. The results of those studies will be publicised when they are finished. 2
International Antibiotic Awareness Week November 16-22: The threat of antibiotics losing their effectiveness has become so serious that the World Health Organisation saw the need for a global campaign to use antibiotics wisely. Under the leadership of the EMA, Fiji organised the week throughout all Divisions with the theme - Antibiotics: handle with care. There were extensive activities during the week including radio spots, Breakfast Show TV panel, TV advertisement, community meetings providing more information on the importance of using antibiotics properly and presentations to patients and staff in hospitals and clinics, backed up with IEC materials: Tshirts, posters, banners, brochures, badges, refrigerator magnets. Funding from the WHO Suva office is gratefully acknowledged as well as the support with IEC materials from Australia s National Prescribing Service. Antimicrobial Stewardship: With the support of FPBSC and the EMA, a WHO consultant undertook an investigation to inform the development of Antimicrobial Stewardship in Fiji. The resulting Fiji National Action Plan was launched in November 2015 during the Antibiotic Awareness Week. The Plan on Antimicrobial Resistance will be available on the MoMHS website. Fiji is the first country among the PICs to develop such a plan. IEC materials The EMA coordinated the production and distribution of IEC materials to all Divisional Hospitals from where they were distributed within the hospitals and clinics as well as to retail pharmacies. Banners on the theme Use Antibiotics Wisely that were displayed in Divisional and Sub divisional hospitals. T Shirts - worn by all pharmacy staff. Information for development as ppt presentations to staff and community members Information leaflets Badges, Frig magnets, Posters provided by WHO. Funding from WHO for the development of IEC materials is gratefully acknowledged, 3
Antibiotic Awareness Week Events: Suva: National media November 12: Talk back on Radio 1. Preparation and orientation about the AB Awareness week that would be held from November 16-22. Questions were answered in English, Itaukei and Hindi languages by Jeremaia Mataika and Avnil Narayan. A Press Release was delivered on the 14 th of November as a preview to the week of 16 th - 22nd November. November 14: Fiji Times article Warning over superbugs Consumer Council of Fiji WITH the world gearing up to mark the first ever World Antibiotic Awareness Week, which will be held from November 16 to 22,... www.fijitimes.com/story.aspx?id=329745 Evening News November 20: Fiji Times Article Antibiotic awareness - Fiji Times Online Antibiotic awareness. Siteri Sauvakacolo Friday, November 20, 2015. ANTIBIOTICS are for infections and they need to be taken only upon prescriptions from..... www.fijitimes.com/story.aspx?id=330489 November 20: Fiji Times Article: Global campaign - Fiji Times Online Friday, November 20, 2015. Ministry of Health staff members at the launch of the Antibiotic Awareness Week in Suva www.fijitimes.com/story.aspx?id=330490 November 20: Breakfast Show Panel, Avnil Narayan and Jeremaia Mataika Avnil and Jeremaia on the Breakfast Show on TV Fiji ONE. November 16-22: TV Commercial made by the FPBS staff, aired on Fiji ONE from Monday until Friday next week during the News breaks. November 18: The campaign was launched at the Headquarters of the MoHMS on Wednesday by the Minister of Health Mr Jone Usamate. The event was covered by the Fiji Times, The Fiji Sun and Fiji ONE Radio and TV. The occasion also marked the launching of Fiji s National Antimicrobial Resistance Plan 4
Fiji is the first country in the region to develop an AMR Plan. The Permanent Secretary of Health and Medical Services, Dr Mecuisela Tuicakau, and the Director of Pacific Technical Support and WHO Representative to the South Pacific, Dr Liu Yunguo, in a group photo with Ministry of Health and Medical Services staff members at the launch of Fiji's National AMR Action Plan The Honourable Minister of Health and Medical Services, Mr Jone Usamate, and the Director of Pacific Technical Support and WHO Representative to the South Pacific, Dr Liu Yunguo, cutting the green ribbon to launch Fiji's National AMR Action Plan at the launching of Antibiotic Awareness Week. http://www.wpro.who.int/southpacific/mediacentre/releases/2015/fiji_launches_amr/en/ 5
Suva, continued FPBSC Delivery van and FPBSC staff below 6
CWM Hospital, Suva Activities Ø CWM Hospital Continuing Medical Education Thursday 19/11 - (2pm 4pm). Ø Pamphlets given to all patients prescribed antibiotics Ø TShirts worn by all pharmacy and FNU staff on Wednesday and Friday Ø One hour lunch time presentation in auditorium to health professionals Ø Short presentations Moreen, FNU Lecturer, Microbiologist, Infection Control NAP presentation - FPBS Dr. Ravi Naidu National Action Plan A/Prof Kannan Overview of Antimicrobial Resistance Ms Shazia Resistance Patterns in CWM Mr Avnil Narayan Antibiotic Resistance a growing concern Presenters were gifted with t- shirts and attendees given souvenirs Awareness Brochures Information sheets and Posters on the ward noticeboards throughout the hospital 7
Nadi Nadi Staff education sessions were held, Materials were available in waiting areas and clinics. Discussions were held with patients collecting prescriptions, 8
Labasa Antibiotics Handle with Care Patient education conducted every morning during the week from 8am to 8.30am The Antibiotic video was played in the waiting area throughout each day Thursday 19 th 1pm to 2pm CME session was conducted Presentation At the end of this presentation, one should be able to: Describe AMR Understand impact of AMR in the health system Be informed about the current situation Become familiar with general principles of Anti- infective use Assist in the implementation of the National Action Plan in combating AMR The Way Forward for Fiji Pictures attached ONE HEALTH APPROACH - (involvement of all actors & sectors like human & veterinary medicine, agriculture, finance, environment and consumers) Fiji National Action Plan to combat AMR with 5 main strategic objectives: Improving awareness and understanding of antimicrobial resistance through effective communication, education and training. Strengthen nationally coordinated surveillance systems. Reduce the incidence of antimicrobial resistance events through improved IPC, sanitation and hygiene, measures and implementation of wellness. Optimise the use of antimicrobial medicines in human and animal health. Establish and ensure governance, sustainable investment and actions to combat antimicrobial resistance. 9
Way Forward for Labasa Collaborative approach team work Awareness & education Patient education prevention & importance of adhering to treatment at all points of care Training ensure that we keep on updating ourselves with new information Strengthen surveillance, reporting and sharing of information in terms of antibacterial resistance Strengthen Infection Prevention & Control measures at all levels Wellness good nutrition & strengthening of vaccination programs Optimize use of antimicrobials Rationalize use at our levels enforcing use of guidelines Ensure sustainability Regular audits & sharing it with other health care teams on usage 10
Lautoka Four presentations were carried out during the week: Tuesday: Continuing Nurses Education(CNE) in the Conference Room from 1 2pm. Wednesday: presentation to patients in SOPD clinic and in the GOPD triage area Thursday: CME for Doctors in the Conference Room from 1 2pm. Ø Posters were pasted in all the wards and at GOPD department Ø Patient counseling and handing over of pamphlets to patients prescribed with antibiotics throughout the week Ø Morning tea for the department (Friday) for their effort in carrying out awareness amidst the busy outpatient and clinics The presentation covered: Overview Antibiotics miracle medicines Antibiotic resistance a critical global problem The link between antibiotic use and resistance Addressing antibiotic resistance Prescribing and using antibiotics with care Whenever they are used, antibiotics must be used with care. 11
Fiji Challenge Surveillance established in the division & strengthened Irrational / inappropriate use private & public Knowledge create awareness to public & health team Work in collaboration with appropriate stakeholders Prescribing policy/guidelines reviewed & enforced Way forward Strategic Plan all stakeholders Human & Animal health Private practitioners & pharmacies with public health & clinical services Formation of National Antimicrobial Stewardship Committee Establish Divisional Antimicrobial Stewardship Committee Awareness special day to be organized Reminder: Antibiotics. Handle with Care Initiate urgent treatment of life- threatening conditions Obtain samples for culture before starting therapy Use Therapeutic Guidelines: Antibiotic Educate and involve patients and carers Document prescription, reason and review date Review treatment and seek advice when necessary Switch treatment when indicated Remember. Antibiotics are a limited, precious resource Antibiotics are a precious resource that could be lost Antibiotic resistance is happening now it is a worldwide problem that affects human and animal health. Antibiotic resistance happens when bacteria stops an antibiotic from working effectively making some infections impossible to treat. Misuse of antibiotics contributes to antibiotic resistance Few new antibiotics are being developed to help solve this problem To preserve the miracle of antibiotics, whenever they are used, antibiotics must be used with care. 12